Assessment of patients with laryngeal symptoms

Assessment of patients with laryngeal symptoms

Patients should be assessed for airway patency. Presence of stridor or respiratory distress should prompt emergency referral to a facility where airway support can be provided quickly if needed.

Following airway assessment, patient history should cover:

• the nature and chronology of voice symptoms
• exacerbating and relieving factors
• patient's voice use and requirement
• presence of associated red flag symptoms
• life style factors e.g. smoking, diet, hydration
• effect on quality of life and psychosocial wellbeing

Investigations commonly include:

• general head and neck examination - oral cavity, oropharynx, and neck
• assessment of the patient's voice - can be done through
  • a simple scale:
    • grade 1 (subjectively normal voice),
    • grade 2 (mild dysphonia),
    • grade 3 (moderate dysphonia),
    • grade 4 (severe dysphonia),
    • and grade 5 (aphonic) plus use of additional qualifiers used as necessary - for example, breathy, strained
      
      
  • GRBAS (grade, roughness, breathiness, asthenia, strain) scale
    • grades hoarseness, roughness, breathiness, aesthenia (weakness), and strain on a scale of 0-3
      • 0 = normal, 1 = mild degree, 2 = moderate degree, and 3 = high degree (1).

Reference:

1. Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827